Abdominal pain of non-visceral origin has been recognised as a clinical entity for
many years. In many gastroenterology clinics up to 50 per cent of patients
attending have no pathological cause to their symptoms and such patients often
become chronic attenders and suffer repeated investigation without resolution of
their problem. They are often left with a label' of Irritable Bowel Syndrome (lBS)
without a precise diagnosis being made. This is both unsatisfactory for the patient
and physician. This study set out to determine the incidence of musculoskeletal
causes of abdominal pain and to determine what diagnostic tools will help identify
this group of patients and thus allow the physicians to refer the appropriate
patients at an early stage. The aims were to identify questions that act as
predictors of the presence of abdominal pain of musculoskeletal origin, patterns of
pain presented in this group of patients and the ability of physiotherapists to detect
cases of abdominal pain of musculoskeletal origin. The incidence of abdominal pain
of musculoskeletal origin in this study was 14 per cent. Questions that act as
predictors include an affirmative response to pain being aggravated by movements
such as bending, twisting and turning, and coughing and sneezing, and a negative
response to change in bowel habit, symptoms being aggravated by food and no
weight change. The ability of the physiotherapist to detect cases was 88.3 per cent.
No particular pattern of pain areas emerged to differentiate patients with
abdominal pain of visceral and musculoskeletal causes. Early assessment of the
musculoskeletal system by a trained physiotherapist is recommended. An early
referral will lead to prompt and appropriate treatment and, consequently, to a
reduction in costs for the NHS. For patients where the cause of their abdominal
pain is not obvious it is unacceptable that they are left with the diagnosis of IBS
without the musculoskeletal system being assessed. This study shows that such an
assessment is vital to detect cases where the pain has a musculoskeletal origin.

Description:

A Doctoral Thesis. Submitted in partial fulfillment of the requirements for the award of Doctor of Philosophy of Loughborough University.